A review of K-wire related complications in the emergency management of paediatric upper extremity trauma

Abstract

INTRODUCTION: Kirschner wires (K-wires) are immensely versatile in fracture fixation in the paediatric population. Complications associated with the K-wiring procedure vary from minor to a life-threatening. The aim of this study was to analyse the outcome of fracture fixation using K-wires in all types of upper-extremity fractures in children in order to assess the incidence and type of complication critically. PATIENTS AND METHODS: Between September 1999 and September 2001, we retrospectively reviewed a consecutive series of 105 fractures in 103 paediatric trauma cases (below 12 years) treated with K-wires in a university teaching hospital. The case notes and radiographs were reviewed by an independent single assessor. All paediatric, acute, upper-extremity, displaced and unstable fractures were included. All elective procedures using K-wires were excluded. RESULTS: We observed an overall 32.3% complication rate associated with the K-wiring procedure affecting 34 pins (24 patients). Wound-related complications included over-granulation in 13 cases, pin tract infection in 6 cases and hypersensitive scar in 1 case. Neurapraxia was found in 3 patients and axonotmesis in 1 patient. Wire loosening at the time of removal in 14 cases and retrograde wire migration in 4 cases were observed. There were 2 cases of penetrating tendonitis and 1 case of osteomyelitis. There was a higher complication rate in terms of wire loosening and pin tract infection when the K-wires: (i) were left outside the skin compared with those placed under the skin; (ii) stayed longer in the patients; and (iii) did not traverse both cortices. There were more complications in complex operations performed by senior surgeons (P = 0.056). The duration of K-wire stay, associated co-morbidity and anatomical location were statistically insignificant. CONCLUSIONS: Complications are part of operative procedures; an important point to consider is what causes them in order to take preventative measures. We recommend that the risks and complications should be explained to parents during the consenting process to allay their anxiety, irrespective of the fact that most complications are minor and of short duratio